Herpes simplex virus in bronchoalveolar lavage fluid of medical intensive care unit patients: Association with lung injury and outcome

Saugel, Bernd; Jakobus, Julia; Huber, Wolfgang; Hoffmann, Dieter; Holzapfel, Konstantin; Protzer, Ulrike; Schmid, Roland M.; Umgelter, Andreas

doi:10.1016/j.jcrc.2015.11.019

Cited by 17 publications

(14 citation statements)

References 30 publications

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“…German researchers discovered that HSV-positive patients had longer HLOS and ICULOS compared to HSV-negative patients, there were no signi cant difference in ICU mortality rate or hospital mortality rate between two groups [14]. In our study, we found virus-positive patients had higher mortality rate and tracheotomy rate.…”

Section: Discussioncontrasting

confidence: 41%

Prognosis of lower respiratory tract infected patients with virus detected in bronchial alveolar lavage fluid: a retrospective observational study

Zhang¹,

Huang²,

Zhou³

et al. 2020

Preprint

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Background and Objectives The influence of virus detected in BALF is still debating. This study aimed to compare the prognosis of lower respiratory tract infected patients with virus detected in bronchial alveolar lavage fluid (BALF) and patients with virus undetected by using metagenomic next-generation sequencing technology.Methods This was a retrospective cohort study. 53 patients with lower respiratory tract infection were enrolled. BALF samples were collected from each patient and sent to perform mNGS pathogenic test in the study. According to the results of mNGS test, patients were divided into virus-detected group and virus-undetected group. In the meanwhile, patients’ clinical information, medical history, disease severity scores, parameters of organ function at the day of ICU admission, prognosis, hospital length of stay, ICU length of stay and needs for medical support were also collected.Results 39.6 percent (21/53) of the BALF samples were virus nucleic acid positive. Mortality rate, tracheotomy rate, mechanical ventilation supporting time, blood transfusion rate were significantly higher in virus-detected group than that in virus-undetected group. Virus-detected was closely related to hospital and ICU survival time.Conclusions Patients with virus detected in BALF were prone to a poorer prognosis. The detection of virus was a high-risk factor of death for LRTI patients. Virus-detected patients required more medical resources.

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Section: Discussioncontrasting

confidence: 41%

Prognosis of lower respiratory tract infected patients with virus detected in bronchial alveolar lavage fluid: a retrospective observational study

Zhang¹,

Huang²,

Zhou³

et al. 2020

Preprint

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“…Several previous studies which examined the impact of acyclovir treatment on survival analyzed ICU mortality at one particular time point [14][15][16]. Since the risk of non-HSV-associated, ICU-acquired complications increases with the length of ICU stay, a survival benefit caused by acyclovir may be underestimated by analyzing mortality after a longer period of time.…”

Section: Discussionmentioning

confidence: 99%

“…Some case reports suggest that acyclovir treatment may improve the clinical course of patients with detectable HSV reactivation [10][11][12][13]; however, this could not be confirmed in larger studies [14][15][16]. To date, only one study has suggested that acyclovir may reduce inhospital and ICU mortality, even after correcting for confounders via propensity score matching [17].…”

Section: Introductionmentioning

confidence: 99%

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

et al. 2020

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Background: Herpes simplex virus (HSV) replication can be detected in the respiratory secretions of a high proportion of ventilated intensive care unit (ICU) patients. However, the clinical significance remains poorly defined. We investigated whether patients with ventilator-associated pneumonia not responding to antibiotics and in whom high levels of HSV could be detected in respiratory secretions benefit from acyclovir treatment. Methods: Respiratory secretions (bronchoalveolar lavage fluid or tracheal aspirates) were tested for HSV replication by quantitative real-time PCR. ICU survival times, clinical parameters, and radiographic findings were retrospectively compared between untreated and acyclovir treated patients with high (> 10 5 HSV copies/mL) and low (10 3 -10 5 HSV copies/mL) viral load.Results: Fifty-seven low and 69 high viral load patients were identified. Fewer patients with high viral load responded to antibiotic treatment (12% compared to 40% of low load patients, p = 0.001). Acyclovir improved median ICU survival (8 vs 22 days, p = 0.014) and was associated with a significantly reduced hazard ratio for ICU death (HR = 0.31, 95% CI 0.11-0.92, p = 0.035) in high load patients only. Moreover, circulatory and pulmonary oxygenation function of high load patients improved significantly over the course of acyclovir treatment: mean norepinephrine doses decreased from 0.05 to 0.02 μg/kg body weight/min between days 0 and 6 of treatment (p = 0.049), and median PaO 2 /FiO 2 ratio increased from 187 to 241 between day 3 and day 7 of treatment (p = 0.02). Chest radiographic findings also improved significantly (p < 0.001). Conclusions: In patients with ventilator-associated pneumonia, antibiotic treatment failure, and high levels of HSV replication, acyclovir treatment was associated with a significantly longer time to death in the ICU and improved circulatory and pulmonary function. This suggests a causative role for HSV in this highly selected group of patients.

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“…Not applicable 3 Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital -Friedrich Schiller University Jena, Jena, Germany. 4 TUM Graduate School, Technical University of Munich (TUM), Munich, Germany.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…fever, impairment of the immune system during critical illness or surgery) [1]. Oropharyngeal HSV reactivation has been shown to occur in 20 to 54% of critically ill patients, depending on the study population and the severity of disease [2][3][4][5][6]. In patients with prolonged mechanical ventilation, HSV can be detected in the bronchoalveolar lavage (BAL) in up to 64% of patients in intensive care units (ICUs) [7].…”

Section: Introductionmentioning

confidence: 99%

Effect of antiviral therapy on the outcomes of mechanically ventilated patients with herpes simplex virus detected in the respiratory tract: a systematic review and meta-analysis

et al. 2020

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Background Herpes simplex virus (HSV) is frequently detected in the respiratory tract of mechanically ventilated patients. The aim of this study was to assess current evidence to determine whether antiviral therapy is associated with better outcomes in these patients. Methods MEDLINE, ISI Web of Science, Cochrane Database and ClinicalTrials.gov were searched from inception to 25 May 2020. All clinical studies investigating the effects of antiviral therapy on the outcome of mechanically ventilated ICU patients in whom HSV was detected in the respiratory tract were eligible for inclusion, regardless of study design, publication status or language. Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed and data extracted. We performed a random-effects meta-analysis to estimate relative risks (RRs) with corresponding 95% confidence intervals (CIs). The primary endpoint was hospital all-cause mortality. Results Nine studies were included in the meta-analysis (one randomized controlled trial, eight cohort studies). Antiviral treatment was associated with lower hospital mortality (with antiviral treatment, 40.6% (189 out of 465 patients); without, 52.7% (193 out of 366 patients); RR 0.74 [0.64, 0.85]; eight studies, low quality of evidence). Furthermore, antiviral treatment was associated with lower 30-day mortality (RR 0.75 [0.59, 0.94]; three studies, very low quality of evidence). We did not observe evidence for differences in ICU mortality (RR 0.73 [0.51, 1.05]; three studies, very low quality of evidence). Conclusions This meta-analysis of the available data shows that antiviral therapy might result in lower hospital and 30-day all-cause mortality in mechanically ventilated ICU patients who are positive for HSV in the respiratory tract. However, this result must be interpreted with great caution due to the high risk of bias and limited number of patients. Large, well-designed randomized controlled clinical trials are urgently needed. Trial registration The study was registered in advance on International Prospective Register of Systematic Reviews (CRD42020180053).

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Herpes simplex virus in bronchoalveolar lavage fluid of medical intensive care unit patients: Association with lung injury and outcome

Cited by 17 publications

References 30 publications

Prognosis of lower respiratory tract infected patients with virus detected in bronchial alveolar lavage fluid: a retrospective observational study

Prognosis of lower respiratory tract infected patients with virus detected in bronchial alveolar lavage fluid: a retrospective observational study

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

Effect of antiviral therapy on the outcomes of mechanically ventilated patients with herpes simplex virus detected in the respiratory tract: a systematic review and meta-analysis

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